Individual
MRS. DEYANIRA GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
Mailing address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LH61318219
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2100261
—
WA
Enumeration date
01/09/2018
Last updated
10/23/2024
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